The Interview

Dr Julia Grace Patterson, a purposeful psychiatrist in her thirties, is recalling the moment PPE shortages for the NHS became critical during the Covid-19 pandemic. She tells me over a Skype video call: “We were having GPs saying, ‘We received insufficient or out-of-date masks which we weren’t sure were safe to use.’ Or, ‘We’ve got to wash down our one visor and use it again.’ Or, ‘masks have been locked away and rationed.’” Patterson points out that NHS staff who weren’t doctors, working outside ICUs – like hospital porters, healthcare assistants and people manning phones – often had no protection whatsoever and they died from the virus in disproportionate numbers: “They lost out and we haven’t even heard their stories. It’s really horrifying.”

You may not have heard of Patterson, nor of Dr Megan Smith, her colleague at the non-profit group EveryDoctor, which represents 1,700 British doctors. I only became aware of their campaigning efforts after I worked myself into a lather about the way vast government contracts for PPE were awarded to companies with no history of manufacturing such equipment – deals pushed through after the usual close scrutiny governing official contracts was suspended at the height of the pandemic. Meanwhile, many companies
that did have proven track records in providing protective gowns, masks and gloves said their calls weren’t returned. In some instances, the mysteriously successful contract winners provided substandard goods that had to be recalled.

The scandal felt like it should have been headline news every day for a year, but – if you’ll excuse a dive into movie-speak – the Covid-19 plot line moved so swiftly (lockdowns, mutant variants, escalating deaths, Covid vaccines, relaxing of restrictions) that it’s sometimes felt hard to sustain outrage. Fortunately for those of us who feel outrage should be upheld and PPE contacts interrogated, Patterson and Smith have kept banging the drum on behalf of healthcare workers. At the end of May, EveryDoctor and The Good Law Project took the UK Government to court, having won the right to a judicial review of certain contracts, alongside the right to contend that the lives of healthcare workers were put at unnecessary risk.

“The motivation isn’t to punish and humiliate Matt Hancock, it’s to say to him OK, you screwed this up, whether you want to admit it or not”

It’s no mean feat to take HM Government to court and for Patterson, who has completed her first three years specialising as a psychiatrist, it’s meant suspending clinical work so she can focus on campaigning. (She cut her activist teeth during the 2016 junior doctors’ protest against new government contracts.) Also, there were suggestions she might face  GMC referral for “speaking up and working within the NHS”, so she decided to step aside while her children were small so she could act as a conduit at EveryDoctor
for concerns colleagues couldn’t openly express. NHS workers are keenly aware there’s an onus on them to steer clear of politics.

At the time we speak, Patterson has just helped coordinate the stealth beaming of a series of messages to Matt Hancock onto various government buildings, including the Department of Health and Social Care and the ExCel Centre (former home of a Nightingale hospital for Covid patients). Sadly, there’s no record of how Hancock responded to “You didn’t give us safe PPE” emblazoned on his department’s front façade.

Barrister-turned-anaesthetist Dr Megan Smith (she practiced at the bar for three years before switching careers) has also put her head above the parapet. Like Patterson, she became involved in campaigning at the time of the junior doctors’ strike and the two connected via EveryDoctor. Smith realised she could utilise her legal background to help the group and has now “resurrected” her practising certificate as a barrister so she can advise members.

I talked to Smith the week after my conversation with Patterson and admired her plain, no-nonsense style. She’s clear the group’s action is not about pursuing political vendettas: “The motivation isn’t to punish and humiliate Matt Hancock, it’s to say to him, ‘OK, you screwed this up, whether you want to admit it or not. Your team clearly tried hard, but you didn’t get all of it right. You didn’t listen to your own government’s reports into exercises to deal with exactly this sort of scenario.”

Dr Megan Smith

Again and again, the EveryDoctor duo make it clear that what they really want to say to Hancock is, in Smith’s words: “So you didn’t get it right. We are where we are. What are you going to do now to make sure that this never happens to our patients and to us again? Because Covid’s around; [it’s] going to be with us for the next year or two at least and with all of the variants, you’re almost effectively getting a new virus every few months. So what’s the plan?”

Patterson says she realised there were widespread concerns about PPE pretty much as soon as the pandemic hit, as she’d grown a sizeable network of doctors up and down the UK. She explains, “We had formed a community and we had very close, trusting links with the doctors we knew.” EveryDoctor had also set up an encrypted email account, where medics can send testimonials and be offered pastoral support when needed. When Covid-19 hit British shores, “we were immediately flooded with an awful lot of anecdotal evidence of what was happening on the front lines.”

EveryDoctor started a big campaign called “Protect NHS Workers,” based on their colleagues’ stark realisation that, “NHS workers didn’t have safe PPE, they didn’t have access to tests, they weren’t being given accommodation away from vulnerable members of their families. And then they were going into Covid wards and coming home, potentially with the virus on them, and passing it to family members.”

Again and again, the EveryDoctor duo make it clear that what they really want to say to Hancock is, in Smith’s words: “So you didn’t get it right. We are where we are. What are you going to do now to make sure that this never happens to our patients and to us again?”

So EveryDoctor started building a cross-party coalition campaign and began weekly briefings to concerned MPs. The bulletins included anonymous testimonial from doctors, which Patterson says would often be along the lines of, “All the masks in our hospital have broken straps and they’re not working properly.” Or, “We’ve run out of gowns, we’re going to run out of gowns in twelve hours’ time.” Or, “We think that within our hospital there’s certain groups of staff who aren’t being offered PPE; for example, BAME staff members.”

Alongside politicians, EveryDoctor worked with the UK and international press to raise awareness of safety concerns, and in mid-May 2020 they were contacted by the The Good Law Project – started by barrister Jolyon Maugham, who famously brought the case blocking Boris Johnson’s attempt to prorogue Parliament. Maugham and his colleagues said they were hoping to take the Government to court on procurement cases and wanted a co-claimant from the healthcare sector. The two campaigning groups joined forces and in the process the lawyers uncovered a VIP, fast-tracking channel for would-be manufacturers of PPE who had government contacts.

Just to be clear, VIP did not refer to the importance of the person seeking the contract, but to the individual who had recommended a company for fast-tracking. What Smith describes as “basically friends and contacts of ministers.” She explains that if these individuals, “went to the VIP lane they were ten times more likely to get a contract than if they were not in the VIP lane, which is pretty significant.” Furthermore, “most of the companies that have an established track record of supplying medical grade PPE to the NHS never got to the VIP lane, they were stuck with the government’s online portal, where they filled in a generic form that got pinged to someone at the bottom of the top and the tiniest fraction of them – I think it’s less than 1% – got any follow up.”

I happen to know what Smith is saying is true, because a friend’s London neighbour had NHS-approved PPE equipment in warehouses, ready to be used, at the start of the crisis but could not get through to officials. Smith tells me this sometimes happened because if enquiries on the official portal were more than five days old the Department of Health might decide they had expired. Which meant companies became stuck in a loop of applying and then being rejected.

Meanwhile, those in the VIP lane often had their calls returned within the hour and, says Smith, “had their hands held through the process” – not because of competence or a background in manufacturing PPE, just because of their connections. This was a process that The Good Law Project and EveryDoctor contend led to highly questionable contracts – which in turn meant the safety of NHS health workers was compromised.

Just to give you some small notion of what Patterson’s talking about, there’s the credulity-defying contract with tiny pest control firm (Pestfix). How on earth was a company with net assets of £18,000, and zero history of manufacturing protective healthcare garments, awarded a contract for £32 million to provide isolation suits? More mind-boggling still, campaigners and journalists delving into the issue discovered the same firm was then awarded a further five contracts totalling £313.7 million. Excuse my shouty capitals but THAT’S OVER A THIRD OF A BILLION POUNDS OF PUBLIC MONEY. And then it transpired two of the three types of face mask Pestfix initially supplied to the Government were faulty and had to be recalled.

It doesn’t stop there, of course. There was also the £108 million contract awarded to a Northern Irish sweet firm, Clandeboye Agencies, who once again – you guessed it – had zero experience in manufacturing PPE. Then there’s Ayanda Capital, “a London-based family office focussed on a broad investment strategy”, who were awarded a contract worth £252 million after Liz Truss’s adviser Andrew Mills appears to have smoothed its path – although due diligence conducted on the company had given it a “red rating” indicating “major concerns” (civil servants said when the contract looked in doubt of being passed through that Mills has “close ties to DIT so wouldn’t be a good outcome”). These are the three firms cited in the current court case. But if you visit the Good Law Project’s website you will find details of other troubling contracts channelled through the VIP lane, alongside the alarming statement: “There remain a further 41 firms yet to be revealed.”

The report stated: “The UK’s preparedness and response, in terms of its plans, policies and capability, is currently not sufficient to cope with the extreme demands of a severe pandemic that will have a nationwide impact across all sectors”

Smith says the cases have been picked as being representative of what went awry: “We’re not necessarily saying the companies that are involved were dreadful suppliers; just it’s the case that hundreds of millions of pounds worth of kit is unusable and has not been distributed to the NHS – and will not be usable by the NHS, because it doesn’t fit the technical and safety specifications… But actually in the case of most of the contracts, those companies have provided what they were contracted to provide. It’s just that the Department of Health and Matt Hancock asked them for the wrong thing.” She characterises it as a classic case of panic-buying, “but we’re stuck with it”. On top of that, warnings were often raised by junior officials, only to be brusquely waved away. Smith’s summary of the situation is succinct: “So, you know, a few hundred million pounds later we’ve got a whole bunch of stuff we can’t use, but they’ve all got a few hundred million pounds of taxpayers’ money in their pocket.”

The case brought by The Good Law Project and EveryDoctor therefore argues that the process for awarding contracts was “irrational” and therefore it was illegal (irrationality is a legal ground for making a contract unlawful). I have to say that irrational feels like an appropriate word for the Government’s behaviour. There’s been a miasma of hysteria hanging over No 10 and the Cabinet at large since the Covid-19 pandemic began. Dominic Cummings’ recent testimony to MPs only confirmed the sense of panic, U-turns and a deficiency of cool, calm rationale.

What impresses me most about Patterson and Smith is that they are quite clear they’re not baying for blood, the toppling of ministers, nor even the downfall of the Government. Patterson admits, “There’s an awful lot [in the news] at the moment about Tory sleaze or cronyism or corruption in money, and that’s obviously a really important, powerful part of all of this and it’s a broad conversation. But from EveryDoctor’s perspective, the bit of it we feel is so important is that this never happens again. That if there’s a future pandemic, we have stockpiles of PPE, we have systems in place so healthcare workers can get a test, all of those really basic things, which were supposed to have been put in place by the Government – and it didn’t happen.”

Because here’s another key factor at the core of this case. In 2016 the Government conscripted 950 officials (central and local government figures, NHS staff, prison workers etc) into a three-day simulation of a “Swan-flu” outbreak affecting half the population and involving 400,000 excess deaths. The simulation was given the name Cygnus and a report was drawn up which stated: “The UK’s preparedness and response, in terms of its plans, policies and capability, is currently not sufficient to cope with the extreme demands of a severe pandemic that will have a nationwide impact across all sectors.” In other words, the Government was thoroughly warned that better systems needed to be put in place and PPE was part of that discussion.

Patterson points out that, as a result of Cygnus, “there was supposed to be a health body set up to oversee the pandemic and coordinate between all the different The report stated: “The UK’s preparedness and response, in terms of its plans, policies and capability, is currently not sufficient to cope with the extreme demands of a severe pandemic that will have a nationwide impact across all sectors” health bodies, so that all of the thinking was joined up and the policies were the same across the UK. They were supposed
to stockpile PPE, they were supposed to have conversation with their regular manufacturers about the fact there might be a surge and what would we do if we needed ten times more masks for a month, or whatever. All of that was meant to go on and it didn’t happen. And that’s what led us here.”

I ask Smith what EveryDoctor hopes to achieve as a result of their court case. She says the campaigners accept that you can’t undo what has been done, because “that ship has sailed”. But what would represent a win for them “would be a declaration that the way they did it and the way that they entered into contracts was irrational and unlawful and that therefore they must not employ that particular process again in the future, if this happens again. So that then they can’t have a VIP lane.” She describes what happened via fast-tracking as being akin to kitting out soldiers “in stuff from JD Sports and sending them out into the field, into battle, because you know the director of JD Sports or whatever. Whereas, what you actually need is proper army kit for proper army people – and that’s what we needed as well.”

As Patterson points out, “we’re in the era of pandemics and climate change,” so the challenges of Covid-19 are hardly likely to prove unique over our lifetimes. All EveryDoctor wants to ensure is that NHS workers never face “these dangerous situations again. Because almost a thousand healthcare workers died on the frontline.”

Dr Megan Smith said “Over five long days the judge heard EveryDoctor and Good Law Project’s case as well as Matt Hancock’s defence. With thousands of pages of evidence, the judge needs time to consider. EveryDoctor expects the judgment in around a month’s time. Until then, campaigning will continue. EveryDoctor will keep pressing Hancock to formulate a pandemic management plan that’s appropriate and safe for healthcare workers, the patients they care so much about, and the wider public.”